Engagement in Antibiotic Stewardship Programs Results in Drop in Antibiotics

Morgan J. Katz, MD, MHS

Robust antibiotic stewardship programs are effective in reducing antibiotic use for long-term care facilities.

A team, led by Morgan J. Katz, MD, MHS, Department of Medicine, Johns Hopkins University School of Medicine, determined if the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use is linked to reductions in antibiotic use in long-term care facilities.

Antibiotic Use in Long-Term Care Facilities

The overreliance on antibiotics is a major issue in healthcare, particularly at long-term care facilities, with 70% of residents receiving at least 1 course of antibiotics annually and 40-75% of prescriptions deemed inappropriate or not concordant with guidelines. However, antibiotic stewardship programs could help reduce the risk of antibiotic resistance at these care facilities.

The AHRQ Safety Program for Improving Antibiotic Use is an educational initiative to establish antibiotic stewardship programs that focus on patient safety.

In the study, the investigators examined data from 439 long-term care facilities in the US. The team assessed antibiotic therapy data following a pragmatic quality-improvement program.

The Program

Training was comprised of over 15 webinars with additional tools, activities, posters, and pocket cards between December 2018 and November 2019.

The investigators sought primary outcomes of antibiotic starts per 1000 resident-days and various secondary outcomes including days of antibiotic therapy per 1000 resident-days, the number of urine cultures per 1000 resident-days, and Clostridioides difficile laboratory-identified events per 10,000 resident-days.

The team compared all outcome data from baseline to the completion of the program and assessed changes over time using generalized linear mixed models with random intercepts.

A Reduction in Antibiotic Use

The results show the mean difference for antibiotic starts from baseline to study completion per 1000 resident-days was -0.41 (95% CI, -0.76 to -0.07; P = .02). Fluoroquinolones had the greatest decrease at -0.21 starts per 1000 resident-days (95% CI, -0.35 to -0.08; P = .002).

In addition, the mean difference of days of antibiotic therapy per 1000 resident-days was not deemed to be significant (-3.05; 95% CI, -6.34 to 0.23; P = .07).

Facilities with greater program engagement, measured by webinar attendance, saw greater reductions in antibiotic starts and use, decreasing antibiotic starts by 1.12 per 1000 resident-days (95% CI, -1.75 to -0.49; P <.001) and days on treatment by 9.97 per 1000 resident-days (95% CI, -15.4 to -4.6; P <.001).

However, there was no significant reductions in law engagement facilities.

Urine cultures per 1000 resident-days also decreased by 0.38 (95% CI, -0.61 to -0.15; P = .001) and there was no significant change in facility-onset C difficile laboratory-identified events.

“Participation in the AHRQ safety program was associated with the development of [antibiotic stewardship programs] that actively engaged clinical staff in the decision-making processes around antibiotic prescriptions in participating [long-term care] facilities,” the authors wrote. “The reduction in antibiotic [days of treatment] and starts, which was more pronounced in more engaged facilities, indicates that implementation of this multifaceted program may support successful [antibiotic stewardship programs] in [long-term care] settings.”

The study, “Implementation of an Antibiotic Stewardship Program in Long-term Care Facilities Across the US,” was published online in JAMA Network Open.